Oasys vs TherapyNotes: Which Is Better for a Group Practice?

Short answer: TherapyNotes is a genuinely well-built EHR with a reputation for support that its long-tenured users defend without prompting. If you're an insurance-heavy practice that values ONC certification and structured, template-driven documentation, it's a strong choice. Oasys is the better fit once a practice grows past roughly 20 users, when per-user pricing without an enterprise tier, per-transaction fees, and the absence of native payroll modeling start to cost more than the software.

Based on our conversations with practice owners, including several long-time TherapyNotes customers.

Let's start with what TherapyNotes does well

We hear more unsolicited praise for TherapyNotes than for any other incumbent, and it would be dishonest to write this page without leading with that.

A practice the better part of a decade in, with a couple of dozen providers:

"In many ways it has been an exceptional product. They have exceptional customer service. I gauge them as a high integrity organization."

Another established practice:

"The utility has been invaluable. I would not have been able to grow and scale without the utility that I'm finding from TherapyNotes."

And on the clinical record specifically: "TherapyNotes probably has a really nice clinical record... from a contractor perspective that feels really good." Plus out-of-the-box usability, which practices name as a genuine strength.

If those are your priorities, you should probably stay. What follows is about the point where the fit stops holding.

At a glance

On pricing. TherapyNotes is $69 a month solo, or $79 for the first clinician plus $50 for each additional one in a group, with unlimited free non-clinical users. Electronic claims, ERAs and text reminders are 14 cents each, email reminders are free. Telehealth, ePrescribe and the AI notes add-on are billed separately. Verified against both vendors' pricing pages on 30 July 2026. The invoice figures below come from customers reading their own bills aloud.

Pricing: it's the fees, not the base rate

TherapyNotes' base per-user price isn't the issue. The issue is that the bill is assembled from transactions.

A practice where more than half the seats belonged to trainees read their invoice out on a call. a monthly bill in the low thousands, itemized as:

• 98 email reminders (free)
• text reminders billed at 14 cents each

Another practice: another practice of similar size, a comparable four-figure bill (down from ~$2,000 before attrition).

And the structural complaint, stated directly:

"There's a point where TherapyNotes is going to get too expensive, because it's a cost per user, they don't offer an enterprise package."

Note the intern ratio in that first example: 23 of 41 seats belong to people who can't yet bill independently, each charged at full rate.

Oasys is $80 per clinician per month, annual, no add-ons, no per-claim, per-ERA, or per-reminder charges.

Payroll: 20 hours a week

The single largest cost we've found in this category doesn't appear on anyone's pricing page.

"About 20 hours a week of our billing manager goes into converting the information in TherapyNotes into a payroll ledger. Which I think you all probably do automatically. So that's our original motivation."

Their compensation structure: one revenue split for contractor day-rate sessions, another for off-hours, and for salaried clinicians a split carrying an hourly minimum plus a monthly commission. Ordinary group-practice arrangements that the software has no way to express , so a person expresses them, every week, forever.

Half an FTE at a loaded $30/hour is roughly $31,000 a year. That is materially more than the subscription.

Oasys models the revenue split natively, with per-therapist overrides, and emits the payroll ledger directly. Payout can be gated on notes being signed and approved.

Integration and the data-integrity problem

TherapyNotes doesn't integrate broadly with third-party tools, which produces a specific and under-appreciated risk. One practice runs a separate assessments platform and a separate analytics tool (the latter at $300 to 400/month), and described the consequence:

"It doesn't integrate with TherapyNotes and so they have to pull the assessment reports and then feed that back into the EHR. And I can guarantee you some of them aren't even doing that."

The cost isn't the subscription to the second tool. It's the assessments that silently never reach the clinical record.

Related, and worth raising with any vendor: practices flagged that revised signed notes don't produce a full change history in TherapyNotes, a genuine exposure during a payer audit. One practice named UHC specifically.

Oasys keeps the full record on an amended note: who unlocked it, the reason given, the content before and after, and when it was re-signed. Other platforms handle this differently, so ask each one directly if you face payer audits.

Practices also report bypassing built-in eligibility checks as insufficiently accurate, going direct to insurer portals instead.

Supervision

Group practices consistently name one requirement as non-negotiable: co-sign workflows that distinguish an intern from a provisionally licensed clinician who is independently credentialed with payers and doesn't legally require a co-signature.

Neither major incumbent models this with enough granularity. Oasys configures supervision per role and per supervisor-supervisee relationship, so a clinician who doesn't need a co-signature can be exempted without disabling supervision across the practice.

Migration: the reason practices stay too long

TherapyNotes users raise one issue more than any other when they consider leaving, and it's not about TherapyNotes' quality:

"TherapyNotes doesn't have a straight migration out of the record. So it was going to take a ton of people hours to do this. So we just felt like we couldn't do that solution."

The same practice, on what that means for their standards:

"We're really not looking for a 95% solution. We're probably looking for a 99% solution for the unbelievable effort this will take. And it's also a decision we have no interest in making twice."

They're right to set the bar there. Practices in this category carry 8 to 11 years of records. The scar tissue is real, one practice's attempted move to another platform was "awful. Bad. So bad." Another paid for white-glove onboarding and still got records "migrated over and done incorrectly."

What to ask us, and everyone else

Because TherapyNotes' export path is the specific problem practices name, migration deserves a direct conversation rather than a line in a comparison table. Ask what moving your particular system would involve, what comes across, and what happens to appointments already booked. Migration is the question we get asked most, so ask us about it directly and we will walk you through what moving your specific system would involve.

Who should choose which

Choose TherapyNotes if ONC certification is a requirement, you're insurance-heavy and happy with template-driven documentation, you value a long track record, or support responsiveness is your single highest priority.

Choose Oasys if you're past roughly 20 users and feeling the per-user ceiling, you're rebuilding payroll manually each month, per-transaction fees are a growing share of your bill, you need supervision you can configure rather than apply blanket, or you need to connect tools via API.

As one practice weighing exactly this put it: "It's not a question of if but when we will transition."